Provider Demographics
NPI:1548563331
Name:ENGEL, DANA CAROL (RDH)
Entity Type:Individual
Prefix:MS
First Name:DANA
Middle Name:CAROL
Last Name:ENGEL
Suffix:
Gender:F
Credentials:RDH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1333 IRIS AVE
Mailing Address - Street 2:
Mailing Address - City:BOULDER
Mailing Address - State:CO
Mailing Address - Zip Code:80304-2226
Mailing Address - Country:US
Mailing Address - Phone:303-443-8500
Mailing Address - Fax:303-450-3699
Practice Address - Street 1:9197 GRANT ST
Practice Address - Street 2:STE 200
Practice Address - City:THORNTON
Practice Address - State:CO
Practice Address - Zip Code:80229-4361
Practice Address - Country:US
Practice Address - Phone:303-869-2173
Practice Address - Fax:303-450-3699
Is Sole Proprietor?:No
Enumeration Date:2010-12-16
Last Update Date:2011-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO902808124Q00000X
101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No124Q00000XDental ProvidersDental Hygienist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO902808OtherSTATE OF COLORADO